CCSP Sports Injury Diagnosis 2 — Questions and Answers
Question 1: A soccer player reports lateral ankle pain after an inversion sprain. The anterior drawer test is positive but the talar tilt test is negative. Which ligament is most likely injured?
- Calcaneofibular ligament
- Anterior talofibular ligament (Correct answer)
- Deltoid ligament
- Posterior talofibular ligament
Correct answer: Anterior talofibular ligament
A positive anterior drawer test with a negative talar tilt indicates isolated anterior talofibular ligament (ATFL) injury, the most commonly sprained ankle ligament.
Question 2: Which mechanism of injury is most associated with a posterior shoulder dislocation in athletes?
- Direct blow to the anterior shoulder
- Fall on an outstretched abducted arm
- Seizure or electric shock with shoulder in internal rotation (Correct answer)
- Forced external rotation with abduction
Correct answer: Seizure or electric shock with shoulder in internal rotation
Posterior shoulder dislocation is classically caused by seizures or electric shock due to powerful, unopposed internal rotator muscle contraction.
Question 3: A gymnast presents with wrist pain over the anatomical snuffbox after a fall. X-rays are negative. What is the most appropriate next diagnostic step?
- Repeat plain films in 10-14 days
- CT scan of the wrist
- MRI of the wrist (Correct answer)
- Bone scan
Correct answer: MRI of the wrist
MRI is the gold standard for early detection of scaphoid fractures when plain films are negative, as it identifies bone marrow edema within 24 hours.
Question 4: A runner complains of lateral knee pain that worsens with downhill running. The Ober test is positive. What structure is most likely involved?
- Lateral collateral ligament
- Biceps femoris tendon
- Iliotibial band (Correct answer)
- Popliteus tendon
Correct answer: Iliotibial band
A positive Ober test indicates iliotibial band (ITB) tightness, and ITB friction syndrome classically presents with lateral knee pain worsened by downhill running.
Question 5: Which Ottawa Ankle Rule criterion mandates radiographic evaluation of the foot rather than the ankle?
- Inability to bear weight immediately after injury
- Tenderness at the posterior edge of the lateral malleolus
- Tenderness at the base of the fifth metatarsal (Correct answer)
- Bony tenderness along the medial malleolus
Correct answer: Tenderness at the base of the fifth metatarsal
Ottawa Foot Rules require radiographs if there is pain in the midfoot zone with tenderness at the base of the fifth metatarsal or navicular.
Question 6: A baseball pitcher develops posterior elbow pain with locking and reduced extension. Imaging shows a loose body in the posterior compartment. What is the most likely diagnosis?
- Medial epicondylitis
- Valgus extension overload syndrome (Correct answer)
- Ulnar collateral ligament tear
- Lateral epicondylitis
Correct answer: Valgus extension overload syndrome
Valgus extension overload syndrome occurs in throwers due to repetitive valgus stress during extension, causing posteromedial olecranon impingement and loose body formation.
Question 7: A volleyball player sustains a hyperextension injury to the PIP joint of the index finger. The lateral X-ray shows the middle phalanx displaced dorsally. What structure is primarily disrupted?
- Central slip of the extensor tendon
- Volar plate (Correct answer)
- Collateral ligament
- Flexor digitorum superficialis
Correct answer: Volar plate
Dorsal PIP dislocation results from volar plate avulsion, as the volar plate is the primary restraint against hyperextension and dorsal displacement.
CCSP Sports Injury Diagnosis 2
A soccer player reports lateral ankle pain after an inversion sprain.
The anterior drawer test is positive but the talar tilt test is negative.
Which ligament is most likely injured?